| NPI | 1528162120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 2822A) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M4186) |
| 208600000X Surgery (Licence: MT 7844) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2007-07-08 |